Referrals to hospital-based rheumatology and orthopaedic services: seeking direction

Speed, Cathy; Crisp, A. J.

doi:10.1093/rheumatology/keh504

Cited by 76 publications

(71 citation statements)

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“…4 Thirty-seven per cent of non-urgent cancer referrals were assessed as being unnecessary according to published guidelines, 5 while 27% of orthopaedic referrals would have been more appropriate for rheumatology. 6 There is also evidence suggesting that, in certain specialties, some patients are not referred until their condition has reached an advanced stage. [7][8][9] Referral-management schemes have been a frequent response to problems of rising outpatient attendances and the associated cost, growth of specialty waiting lists, inappropriate referral, and variation in clinicians' referral rate and quality.…”

Section: Introductionmentioning

confidence: 99%

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

Cox

Steel

Clark³

et al. 2013

Br J Gen Pract

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BackgroundNinety-one per cent of primary care trusts were using some form of referral management in 2009, although evidence for its effectiveness is limited. AimTo assess the impact of three referralmanagement centres (RMCs) and two internal peer-review approaches to referral management on hospital outpatient attendance rates. Design and settingA retrospective time-series analysis of 376 000 outpatient attendances over 3 years from 85 practices divided into five groups, with 714 000 registered patients in one English primary care trust. MethodThe age-standardised GP-referred first outpatient monthly attendance rate was calculated for each group from April 2009 to March 2012. This was divided by the equivalent monthly England rate, to derive a rate ratio. Linear regression tested for association between the introduction of referral management and change in the outpatient attendance rate and rate ratio. Annual group budgets for referral management were obtained. ResultsReferral management was not associated with a reduction in the outpatient attendance rate in any group. There was a statistically significant increase in attendance rate in one group (a RMC), which had an increase of 1.05 attendances per 1000 persons per month (95% confidence interval = 0.46 to 1.64; attendance rate ratio increase of 0.07) after adjustment for autocorrelation. Mean annual budgets ranged from £0.55 to £6.23 per registered patient in 2011/2012. RMCs were more expensive (mean annual budget £5.18 per registered patient) than internal peer-review approaches (mean annual budget £0.97 per registered patient). ConclusionReferral-management schemes did not reduce outpatient attendance rates. RMCs were more expensive than internal peer review.

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Section: Introductionmentioning

confidence: 99%

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

Cox

Steel

Clark³

et al. 2013

Br J Gen Pract

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“…The 856 orthopaedic conversion rate (the proportion of referred patients who are ultimately listed for surgery) at such clinics is typically only 30-37% [6,7]. This issue had led groups to restructure their musculoskeletal services with patients selected following screening of referral letters to be seen in clinics staffed by general practitioners with a specialist interest and physiotherapists.…”

Section: Discussionmentioning

confidence: 99%

Inpatient consultations to an orthopaedic service: the hidden workload

et al. 2011

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“…10 The absence of previous investigation results was noted in more than 50% of the referral letters in three separate studies, 3,22,24 patients' medical history was not routinely included in referral information, 13,16,25 and allergies 16,23 and clinical findings 5,17,18,22 were generally poorly recorded. These omissions may be due in part to the fact that there is no real consensus amongst different specialties on the ideal information to be included in a referral letter, beyond an agreement on broad information categories.…”

Section: Discussionmentioning

confidence: 99%

Smoothing the passage of patients from primary care to specialist respiratory opinion

O'Byrne

Darlow

Roberts

et al. 2010

Primary Care Respiratory Journal

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Aims: To assess whether information in general practitioner (GP) referral letters provides a basis for selection of diagnostic tests in patients referred for specialist respiratory advice. Methods:We undertook a prospective study within a respiratory outpatients department to compare the diagnostic tests planned at three stages of the referral/specialist consultation process: i) using the GP referral letter alone; ii) using the referral letter and patient history; iii) using the referral letter, patient history, and clinical examination.Results: Analysis of the content of GP referral letters revealed wide variations in referral information. A high proportion of tests selected using the referral letter alone were altered after specialist history-taking and examination. Far fewer changes were recorded between history-taking and examination.Conclusions: Neither literature review nor our study support a system which bases diagnostic test selection on GP referral letters alone. However, our findings suggest that approaches which include specialist history-taking in advance of face-to-face consultation merit further investigation.

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Referrals to hospital-based rheumatology and orthopaedic services: seeking direction

Cited by 76 publications

References 0 publications

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

Inpatient consultations to an orthopaedic service: the hidden workload

Smoothing the passage of patients from primary care to specialist respiratory opinion

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